Less than half mothers in UK breastfeed after 2 months - some reasons why

Key conclusions: "A survey of 500 mothers commissioned by PHE found that fears about breastfeeding among women included that it could be painful (74%), prevent them taking medication (71%) and be embarrassing in front of strangers (63%)."https://www.theguardian.com/lifeandstyle/2017/mar/23/less-than-half-of-women-breastfeed-after-two-months-survey-finds?CMP=share_btn_fb

What women want in order to breastfeed - recent study

What do women really want for breastfeeding support?

This study explored new mothers’ attitudes towards breastfeeding promotion and education to consider where improvements could be made. Mothers identified a need to move away from the perception that breastfeeding is best (rather than normal), an emphasis on wider values other than the health benefits of breastfeeding, and a message that every feed, rather than just 6 months exclusive breastfeeding, matters. Mothers also highlighted the need for promotion and education to target family members and wider society rather than simply mothers themselves, all of whom influenced both directly or indirectly the maternal decision and ability to breastfeed.

Brown, A, (2016), What Do Women Really Want? Lessons for Breastfeeding Promotion and Education. Breastfeeding Medicine, doi:10.1089/bfm.2015.0175

'Extended breastfeeding' - what does it mean?

The term 'extended breastfeeding' seems to imply that it is longer than the 'norm'. So what is the 'norm' for breastfeeding?  In Ireland, there are statistics available for breastfeeding initiation (55.6% in 2013).  However, statistics are not routinely collated for breastfeeding continuation, never mind weaning age.  

The World Health Organisation recommends that babies are breastfed exclusively for 6 months and continue to be breastfed up to 2 years and beyond.

Lawrence 1999 is often cited with the world average being '4 years', Informal research by Dr. Katherine Dettwyler, anthropologist at Texas A&M University, argues that the natural weaning age for human beings falls between 2.5 and 6 years of age: www.llli.org/ba/feb01.html.

Lawrence, R. A. and R. M. Lawrence. Breastfeeding:A Guide for the Medical Profession. St. Louis: Mosby, 1999.

Dettwyler, K. A. A time to wean. BREASTFEEDING ABSTRACTS 1994; 14:3-4.

Statistics for breastfeeding beyond initiation are difficult to get worldwide as they are not routinely collated.  In this study of 179 breastfeeding mothers at a La Leche League Conference int he US, the average age of weaning was 2.5 years (3 years for the youngest child).  

Sugarman M, Kendall-Tackett KA. Weaning ages in a sample of American women who practice extended breastfeeding. Clin Pediatr (Phila). 1995 Dec;34(12):642-7.

 

Pierre Robin Sequence (sometimes referred to as syndrome)

If a baby has Pierre Robin Sequence (PRS), the jaw is underdeveloped and many mothers are told that they can't breastfeed (or even bottlefeed the usual way) - but some can depending on severity. Mothers can 'exclusively breastfeed' if they wish by pumping their milk and using 'expressed breast milk' known as EBM.  This does take time and effort for the mother, but mothers have done it and continue to do so.  Another alternative is mixed feeding where mother uses a combination of her own milk and alternatives to breastmilk.  It is not an 'all or nothing' situation as mothers need to balance their own needs and family circumstances to do what they can.  As the face and jaw develops, it may become easier for baby to feed either at the breast or from a bottle but this may take up to two years for some babies. The following links may be useful for this sequence and other facial conditions. PRS often comes with associated conditions as baby gets older.  . The KellyMom article has links to this topic and other sources on alternative feeding methods too.  http://www.lalecheleague.org/lllea.../lv/lvoctnov01p111.html.  http://kellymom.com/bf/pumpingmoms/feeding-tools/alternative-feeding/

 

Breastfeeding: “single most effective investment a country can make”

Breastfeeding: “single most effective investment a country can make” (Hansen 2015)

The World Bank is the largest source of finance for developing countries: it invests in a wide range of development areas in every developing country worldwide such as clean energy, education, health, and water:  “the World Bank sees breastfeeding as a crucial cornerstone of any sound social policy (Hansen 2015)

The author of this article cites Breastfeeding as a very simple and powerful intervention, recognising that it seems odd to use the word ‘intervention’ to describe the “the second most natural behavior of the species” that humans have practised for half a million years but has begun to decline due to modern living. 

Hansen describes breastfeeding as “a natural, renewable food source that needs no packaging, no transportation, no storage, no cooking, and no refrigeration. It goes with you, and it is environmentally friendly”.

“It is a win–win for the health of the mother and the child”

“it has a very, very high rate of return as a pure financial investment”

Breastfeeding: “in sheer, raw bottom-line economic terms, this may be the single most effective investment a country can make in any sector for any reason! [my emphasis]

All the quotations above are from an article by:

Keith Hansen, JD, MPA Global Practices Vice President The World Bank Washington, DC E-mail: abm@bfmed.org

Reference

Hansen K. (2015) The Power of Nutrition and the Power of Breastfeeding. Breastfeed Med 10(8), 385-388.

The article by Keith Hansen in The Journal of Breastfeeding Medicine derives from his presentation at the Seventh Annual Summit on Breastfeeding, First Food: The Essential Role of Breastfeeding, June 2015.

Reference

Hansen K. (2015) The Power of Nutrition and the Power of Breastfeeding. Breastfeed Med 10(8), 385-388, available at:  http://online.liebertpub.com/doi/full/10.1089/bfm.2015.0113

 

Breastfeeding support - A Tapestry of Support

A Tapestry of Support

"Tapestries are both beautiful and strong, and the beauty of and strength come from the diversity of types of support interwoven together." 

"When mothers are adequately supported to breastfeed, everyone - the baby, the mother, the family, the community - benefits." 

Source: Clark Vickers M., ed (2012) Why breastfeeding women need mothers support. Hale Publishing, Amarillo, TX, United States.

Is my baby's sleep normal?

Sleep

A recent interesting white paper on sleep by Cassels et al 2013 published by Praeclarus Press made some research references to ‘normal’ infant sleep, especially in relation to breastfeeding and bedsharing.  All references are in the original article at: http://www.praeclaruspress.com/WhitePapers/praeclarus_press_normal_infant_sleep.pdf

Many mothers seem to be very concerned and worried about their baby’s sleep patterns (or lack of one) leading to them not getting their ‘eight hours’ which may not be normal for adult humans either.  A sleep historian, Roger Ekirch, author of ‘At Day's Close: Night in Times Past’ maintains humans naturally slept for two ‘four-hour blocks’, getting up in the middle of this time to do tasks and then going back to sleep.  This behaviour would now be considered ‘insomnia’ with medication prescribed so people could get their full 8 hours’ sleep again.  Some of the most interesting references in this article are:

What is normal?

The notion of 8 hours’ sleep may be more to do with the industrial revolution and the invention of the electric light bulb, according to Ekirch, and nothing to do with our natural sleep rhythms.  Babies, who don’t have to get up in the morning to go to work, may be more in tune with natural sleep patterns and it is the adults who are doing it all wrong!

Formula feeding does not guarantee more sleep!

Cassels et al. note that with human milk containing less protein and fat than cow’s milk making it necessary for babies to feed more often, formula milk also contains other additives that make it more difficult and slower to digest inducing a much deeper sleep making it more difficult for babies to arouse.  However, the use of formula does not necessarily result in babies sleeping more overall (Doan, Gardiner, Gay, & Lee, 2007; Kendall-Tackett, Cong, & Hale, 2011 cited in Cassels et al., 2013) with Weinraub et al. 2012 maintaining that all babies wake up regularly at night regardless of how they are fed. 

Breastfeeding mothers get more sleep!

Kendall-Tackett et al. 2011 found that breastfeeding mothers get 45 minutes more sleep than either formula-only or mixed-feeding mothers with Doan (2007) suggesting that supplementing results in less sleep overall than even formula only. 

Babies don’t have a pattern!

Babies who had been sleeping for long periods may suddenly wake more often between 6 to 12 months (Scher, 1991, 2001)with one longitudinal study finding that between 3 and 42 months there was no stability in waking or duration for any babies (Scher, Epstein, & Tirosh, 2004).

Some babies go to bed with their parents!

One study noted that babies in Asia tend to go to bed at the same time as their parents with Hong Kong babies going to bed at around 10.17pm as opposed to babies in the West who go at 8.44pm – these are average figures (Mindell, Sadeh, Wiegand, How, & Goh, 2010). 

Bed-sharing does not harm the marital relationship!

Recent research has found that there is no harm to the marital relationship when bedsharing is intentional – it seems that it is only when bedsharing occurs because the baby is not perceived to be sleeping that it becomes a problem (Messmer, Miller, & Yu, 2012).

Night-time breastfeeding promotes sleep!

Night-time breastmilk contains tryptophan (sleep-inducing amino acid) while amino-acids are also credited in promoting serotonin synthesis (Delgado, 2006; Goldman, 1983; Lien, 2003): serotonin keeps one happy and helps sleep-wake cycles (Somer, 2009). 

 

It is normal for infants to prefer to sleep in contact with others

Cassels et al. note a study which suggested that babies like to wake up in the same environment that they fell asleep in as otherwise they wake up crying, especially if they fell asleep in mother’s arms at her breast and wake up alone in a cot or even another room (Anders, Halpern, & Hua, 1992).  Most adults probably don’t like waking up somewhere strange either!

 

References

 (cited in original article by Cassels et al 2013 online at http://praeclaruspress.com/wp-content/uploads/2013/08/praeclarus-press-normal-infant-sleep-2.pdf

 

Anders, T.F., Halpern, L.F., & Hua, J. (1992). Sleeping through the night: a developmental perspective. Pediatrics, 90, 554-560.

Cassels,T. ; Ockwell-Smith, S.; Middlemiss, W.; Kendall-Tackett, K.; Stevens , H.; McKenna, J. & Narvaez, D. 2013.   Is Your Baby’s Sleep a Problem?  Or Is It Just Normal?  Mother-Baby Sleep Experts Weigh in on Normal Infant Sleep.   A Praeclarus Press White Paper.  Published online August 22, 2013 at www.PraeclarusPress.com.

Delgado, P.L. (2006). Monoamine depletion studies: Implications for antidepressant discontinuation syndrome. Journal of Clinical Psychiatry, 67(4), 22-26.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breast-feeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21, 200-206.

Goldman, A. S. (1993). The immune system of human milk: Antimicrobial anti-inflammatory and immunomodulating properties. Pediatric Infectious Disease Journal, 12(8), 664-671.

Lien, E.L. (2003). Infant formulas with increased concentrations of α-lactalbumin. American Journal of Clinical Nutrition, 77(6), 1555S-1558S.

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. T. (2010). Cross-cultural differences in infant and toddler sleep. Sleep Medicine, 11, 274-280.

Mindell, J. A., Telofski, L. S., Weigand, B., & Kurtz, E. S. (2009). A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep, 32, 599-606.

Scher, A. (1991). A longitudinal study of night waking in the first year. Child: Care, Health and Development, 17, 295-302.

Scher, A. (2001). Attachment and sleep: A study of night-waking in 12-month-old infants. Developmental Psychobiology, 38, 274-285.

Somer, E. (2009). Eat your way to happiness. New York: Harlequin.

 

When is a good time to introduce solid foods to my baby?


Mothers often worry about when the best time is to introduce foods other than breastmilk. Around the age of 6 months is the time recommended by The World Health Organization.  The HSE, and other countries such as the UK and Australia follow these guidelines and here are some useful links: See

http://www.llli.org/faq/solids.html
http://www.nhs.uk/…/docume…/pdfs/introducing_solid_foods.pdf
https://www.breastfeeding.ie/…/When-should-I-start-introduc…;https://www.breastfeeding.asn.au/bfinfo/solids.html;

Recent Breastfeeding Research in Ireland - Gallagher et al 2015

Research has just been published by researchers at Trinity College Dublin from a study done in 2008 with 2572 women in all maternity hospitals in Ireland.

Gallagher L., Begley C. & Clarke M. (2015) Determinants of breastfeeding initiation in Ireland. Irish Journal of Medical Science, 1-6.

This is the first nationally representative study to measure breastfeeding prospectively following hospital discharge.  While 2527 women were initially recruited, 1826 were still participating at 3-4 months (Phase 2).  The main findings from Phase 2 were that the majority of mothers had: private health insurance (66%); were married (76%); employed (77%); aged 30-34 years (39%): mean age 31 years. 

56% mothers initiated breastfeeding at birth; 42% exclusively breastfeeding at 48 hours;  2.4% mothers exclusively breastfeeding at 6 months

Irish women less likely to initiate breastfeeding (52.6%).  Women not born in Ireland more likely to initiate: Polish 82.2%; Other nationalities 74.6%; British women 64.5%

Professional, managerial, and technical workers more likely to breastfeed (70% and 69%)

35% of mothers who discontinued in Phase 2 (up to 3-4 months) did so in first 2 weeks

55% of mothers in Phase 2 fully formula feeding by 1 month